Consecutive Laparoscopic Adjustable Gastric Banding Research Articles

Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic-Adjustable Gastric Banding.

Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome. Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m2-1. A total of 155 patients (77.1%; 95% confidence interval, 71%-83%; p<0.0001) were discharged home within 2-3 hours of surgery, whereas 36 stayed for 23 hours and 10 required hospital admission for 1-2 days. Increased surgical port numbers (p=0.007), ≥50% of total intraoperative fentanyl administered in the recovery room (post-anaesthesia care unit) for the treatment of postoperative pain (p=0.007) and a lack of prophylactic beta-blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnoea was not associated with a non-ambulatory outcome (p=0.83). The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.

Rebanding for Slippage After Gastric Banding: Should We Do It?

Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. LAGB is frequently complicated by slippage. Possible treatment for slippage is rebanding, but long-term effects are unknown. The aim of this study was to investigate whether rebanding after gastric band slippage is associated with weight loss failure. This was a post hoc analysis of a prospectively collected database of 627 consecutive LAGB patients. Rebanding for slippage was performed in 81 patients. The effect of rebanding on weight loss was evaluated by three analyses: (1) in 81 rebanded patients, weight loss was compared before and after rebanding, separately for patients in whom primary LAGB was successful or unsuccessful; (2) 81 rebanded patients were matched to 81 patients without slippage for prognostic variables and compared for weight loss after rebanding; (3) multivariate logistic regression was performed whether rebanding was independently associated with weight loss failure. The chance of a fair result of rebanding for patients following primary successful (n = 34) and unsuccessful LAGB (n = 22) was 62 and 27% after median follow-up of 113 and 97months, respectively. There was no difference in weight loss failure between 81 rebanded patients and 81 matched patients: 54 vs 59% (P = 0.43). In multivariate analysis, rebanding was not significantly associated with weight loss failure: adjusted odds ratio 1.42; 95% confidence interval 0.85-2.38; P = 0.18. In general, rebanding after LAGB has no negative effect on weight loss. However, patients in whom LAGB was unsuccessful prior to rebanding have poor long-term weight loss results.

Does weight loss affect the apnea/hypopnea index?

Does weight loss affect the apnea/hypopnea index?

Travel distance as factor in follow-up visit compliance in postlaparoscopic adjustable gastric banding population

Background Despite the 2008 “American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient,” consensus does not exist for postoperative care in laparoscopic adjustable gastric banding (LAGB) patients (grade D evidence). It has been suggested that regular follow-up is related to better outcomes, specifically greater weight loss. The aim of the present study was to investigate the effects of travel distance to the clinic on the adherence to follow-up visits and weight loss in a cohort of LAGB patients in the setting of a rural, university-affiliated teaching hospital in the United States. Methods A retrospective chart review was performed of all consecutive LAGB patients for a 1-year period. Linear regression analysis was used to identify the relationships between appointment compliance and the distance traveled and between the amount of weight loss and the distance traveled. Results Linear regression analysis was performed to investigate the effect of the travel distance to the clinic on the percentage of follow-up visits postoperatively. This effect was not significant ( P = .4). Linear regression analysis was also performed to elucidate the effect of the travel distance to the clinic on the amount of weight loss. This effect was significant ( P = .04). Conclusion The travel distance to the clinic did not seem to be a significant predictor of compliance in a cohort of LAGB patients with ≤1 year of follow-up in a rural setting. However, a weak relationship was found between the travel distance to the clinic and weight loss, with patients who traveled further seeming to lose slightly more weight.

Radiological features of complications of laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is used to treat morbid obesity. We reviewed the associated complications with emphasis on radiological features and the role of radiology in suspected complications. Between 30 January 2001 and 3 October 2006, 313 consecutive LAGB patients' data was entered into a prospective database. A contrast swallow was routinely performed on the first postoperative day, and port adjustments were done at variable intervals. Additional radiological studies were performed in patients with suspected complications. Of 313 patients who underwent LAGB, 46 had 51 complications (16.3%). The commonest complications were LAGB system leakage (5.1%), anterior band slippage (3.5%) and infected port (1.6%). Two mortalities (0.6%), one early and one late, occurred. LAGB is a relatively low-risk procedure widely performed for treating morbid obesity. Imaging plays a pivotal role in the early evaluation and detection of LAGB complications.

Management of slipped adjustable gastric bands

Background A small percentage of patients undergoing laparoscopic adjustable gastric banding (LAGB) experience band slippage that might require subsequent surgical intervention. We present our experience with band slippage in 660 consecutive LAGBs performed since November 2001 in order to determine the optimal management for slipped gastric bands. Methods The treatment options for patients with slipped bands include band removal, gastric reduction and reapplication of the original band, and band replacement. Data from electronic medical records, as well as telephone interviews, were collected and tabulated. The original weight and body mass index, weight and body mass index before the revisional procedure, and the most recent weight, body mass index, and percentage of excess weight loss are presented. Results Of the 660 LAGB patients, 34 (5%) experienced band slippage and required 40 subsequent operative procedures. Of the 34 patients, 6 underwent multiple procedures for their slipped band. Overall, 10 removals, 13 gastric reductions, and 17 replacements were performed (40 total procedures). Of the 34 patients, 28 (82%) were available for follow-up. This group of 28 patients underwent 34 operative procedures (7 removals, 11 gastric reductions, and 16 replacements). No complications were associated with these 34 operations. Of the 11 patients with gastric reduction, 6 (55%) had subsequent recurrence of band slippage, resulting in 6 additional operations (5 replacements and 1 removal). Conclusion After band slippage, all 3 management options result in maintenance of most of the lost weight. However, because a large number of patients who undergo gastric reduction experience repeated slippage and require additional surgical intervention, gastric reduction should not be routinely performed in this population. Given the overall experience with revisional surgery after band slippage, additional investigation of the etiology of band slippage and its prevention is warranted.

Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results

This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common. Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 +/- 24 kg, mean BMI 46.2 +/- 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, short- and long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy. Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5). Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7 %), and other 1 (0.05 %). Port-related complications occurred in 200 patients (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation ("bandinaro") in 24 (1.3%). Weight in kg was 103.7 +/- 21.6, 102.5 +/- 22.5, 105.0 +/- 23.6, 106.8 +/- 24.3, 103.3 +/- 26.2 and 101.4 +/- 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 +/- 7.1, 37.2 +/- 7.2, 38.1 +/- 7.6, 38.5 +/- 7.9, 37.5 +/- 8.5 and 37.7 +/- 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group. LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount.

Three-year follow-up weight loss results for patients undergoing laparoscopic adjustable gastric banding at a major university medical center: does the weight loss persist?

Background Very few large United States series with long-term data after laparoscopic adjustable gastric banding (LAGB) have been published. Here, we present results of 409 consecutive LAGBs performed at a major United States medical center. Methods Charts were retrospectively reviewed for perioperative morbidity, mortality, and repeat operations. Weight loss data were collected during band adjustments. Results Mean age of patients was 42 years. Mean preoperative weight and body mass index (BMI) were 142.4 kg and 50.6 kg/m 2, respectively. There was 1 fatal myocardial infarction and 4 nonfatal pulmonary emboli. There were 50 (12%) repeat operations resulting in 16 (4%) bands being removed. Mean excess weight loss was 23.7%, 44.3%, 48.0%, and 53.3% with <1 year, 1 to 2 years, 2 to 3 years, and >3 years of follow-up, respectively. Conclusions Three-year follow-up data demonstrated continued weight loss in patients after LAGB. The relative safety and continued adjustability of LAGB make it an appealing option for long-term weight loss.

Laparoscopic Adjustable Gastric Banding: 1,014 Consecutive Cases

The purpose of this study was to examine 1,014 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 48 months of followup, including evolution and changes in surgical technique, learning curve issues, weight loss outcomes, and complications. Between October 2000 and December 2004, 1,014 consecutive patients (81.8% women, mean age 42.3 years, mean body mass index 47.7 +/- 8.6 kg/m(2)) underwent LAGB operation at our center. Perigastric dissection was used in the first 44 patients; pars flaccida technique was used for the latter 970 patients. Fluoroscopy-guided adjustments were performed and patients received intensive followup. Excess weight loss at 12, 24, 36, and 48 months was 40.5 +/- 17%, 52.9 +/- 19.5%, 62 +/- 20.9%, and 64.3 +/- 19%, respectively, with data available in > 85% of patients who had reached each of the time intervals. Patients with lower preoperative body mass index had higher excess weight loss initially, but this difference was not apparent at 3 and 4 years' followup. At 36 and 48 months, respectively, 73.5% and 75% of patients had > 50% excess weight loss. Perigastric dissection led to 9 of 44 (20.5%) slippages, compared with 14 of 970 (1.4%) with pars flaccida technique. Other complications included 2 erosions (0.2%), 5 tubing breaks (0.5%), 7 access port problems (0.7%), and 14 acute stoma obstructions (1.4%). Eight (0.8%) bands were explanted. No deaths occurred. LAGB can achieve effective and safe weight loss. Change from perigastric to pars flaccida technique reduced slippage rate. Preoperative body mass index alone was not found to be a predictor of effective weight loss in the longterm.

Laparoscopic Adjustable Gastric Banding: Early Experience in 400 Consecutive Patients in the USA

Early experience with 400 consecutive patients who underwent laparoscopic adjustable gastric banding (LAGB) is reported. From Nov 2002 to Aug 2004, prospective data were collected on 400 consecutive LAGB patients and evaluated retrospectively. There were 354 (88.5%) females and 46 males (11.5%), with mean age 43.6 years and mean BMI 46.2 kg/m2. For outpatients (freestanding ambulatory surgery center), mean OR time was 55.4 min in 208 patients (52%), compared to mean inpatient OR time of 70.5 min in 192 patients. Inpatients had a higher BMI (48.2 +/- 9.3 SD) than outpatients (43.9 +/- 5.7 SD) (P<0.0001). Complications occurred in 35 patients (8.8%). These consisted of 9 slipped bands (2.3%) that were surgically repositioned, 6 port problems (1.5%) that were successfully repaired, 17 patients with temporary stoma occlusion (4.3%) that spontaneously resolved, and 2 bowel perforations (0.5%) that required surgical repair and band removal. One patient died of pneumonia 2 weeks after an uneventful procedure. Average 1-year percent excess weight loss (%EWL) in 138 patients was 48.2%. Patients who had < or =50 kg initial excess weight (n=37, 27%) had a significantly higher %EWL (55.2%) at 1 year than patients who had >50 kg initial excess weight (P=0.0011). LAGB has been safe and effective thus far for the surgical treatment of morbid obesity, and can be performed as an outpatient in select patients.

Early and Late Complications following Laparoscopic Adjustable Gastric Banding

There is limited U.S. data on short- and long-term complications of laparoscopic adjustable gastric banding (LAGB) as a treatment option for morbid obesity. Hereafter, we present our experience with the first 154 consecutive LAGBs performed at Loyola University Medical Center. Inpatient and outpatient charts were reviewed retrospectively for all patients undergoing LAGB between November 2001 and February 2003 for perioperative morbidity and mortality and repeat operations. Thirty-seven men (24%) and 117 women (76%) underwent LAGB in a 16-month period. There was one (0.6%) death from postoperative myocardial infarction (MI) and one (0.6%) pulmonary embolism. Six (3.9%) patients required readmission to the hospital for dehydration. During a mean follow-up of 33 weeks (range, 4-69 weeks), 14 (9%) patients required repeat operations. There were five (3.2%) band slippages and one (0.6%) gastric erosion. Three bands were removed laparoscopically. Three slippages were revised laparoscopically. One patient underwent laparoscopic cholecystectomy. Seven patients (4.5%) required port revisions for catheter disconnection (4), leak at port site (2), or flipped port (1). LAGB is a safe operative approach for the management of morbid obesity. The incidence of postoperative complications can be minimal with application of a standardized technique. LAGB should be strongly considered for morbidly obese patients who have failed nonoperative management.